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I. ~`'- <br />~o'U <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEENAME: ~ <br />Forest Lakes Metro District ~~~*~~~~~ <br />PERMIT NO.: <br />OPERATION NAME: <br /> <br />ANNIVERSARY DATE: / <br />/ M-1981-158 <br />Forest Lakes Pit #1 <br />January 26, 2007 ~ JAN <br />2 2 2~~] <br />~/ Division of Reclamation, <br />Mining and Satety <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <br />According"to C:R.S-34=325=I'I'b-or'C~S~34=3Z=f-Yfi;'each=year,-o-n-the=anmversaty=date o~the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated man. If no new disturbances or reclamation have occurred durinti the arevious year and no <br />new chanties to the previous year's map are necessary. then no new map is required, nrovided that the <br />Oaerator shall state this in the Auuual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dale Kortr <br />Permittee Name: Forest Lakes Metro District <br />Address: P.O. Box 440 <br />Phone Number: <br />Fax Number: <br />If you have additio <br />below or attach it <br /> <br />Bayfield, CO 81122-0440 <br />(970)884-2925 <br />(970)884-0305 <br />comments and/or information that should be provided to the Division, please provide it <br />this form along with your written report and map. Annual Report instructions aze <br />or <br /> <br />M: WER.W 11MASTERD000MENTSVv]-AF-Od <br />